Bill > S296

Introduced Session

This bill places certain requirements on carriers offering health benefits plans with a tiered network. A tiered network is a managed care plan provider network with more than one level or tier of in-network benefits, based on different levels of reimbursement and cost sharing accepted by the health care providers in that network. Carriers include an insurance company, health service corporation, hospital service corporation, medical service corporation, or health maintenance organization authorized to issue health benefits plans in this State, the State Health Benefits Commission and the School Employees' Health Benefits Commission. The bill also specifies that a carrier must report on its website and in plan documents supplied to the subscriber the actuarial value of a health benefits plan with a tiered network. Additionally, the cost sharing amount associated with the lowest or least preferred tier of the health benefits plan must be, at a minimum, actuarially equivalent to the cost sharing associated with a silver level of coverage for a silver health plan offered in the Health Insurance Marketplace created through the Affordable Care Act, as defined in 45 C.F.R. 156.140. Finally, the bill requires that any tiered network plan include University Hospital, and any other general or acute care hospital that is designated an instrumentality of the State, in the highest or preferred tier of the network.

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Nia Gill (D)*,  Joe Vitale (D)*,  Brian Stack (D), 

Referred to Senate Budget and Appropriations Committee (on 06/06/2016)